Screening new inmates for HIV may not reveal many new undetected cases, study shows

Nov. 26, 2013

More than 90 percent of HIV-infected inmates entering prison in North Carolina previously had tested positive for the virus, according to a study published in the Nov. 27 issue of the Journal of the American Medical Association.

A significant proportion of people with HIV in the United States enter the prison system each year, and many have believed that screening new inmates for HIV would yield a number of new diagnoses.

“We found that was not the case, and that few of the HIV-positive individuals coming into state prison in North Carolina had not previously been diagnosed with HIV,” said David Wohl, MD, associate professor of infectious diseases at the University of North Carolina School of Medicine and lead author of the paper.

Drs. Carol Golin (left) and David Rosen attended a ceremony in 2007, during which Rosen won a Graduate School Impact Award for his research about N.C. prison inmates.

Carol Golin, MD, associate professor of health behavior in the Gillings School of Global Public Health, and two Gillings School alumni, Becky White, MD, and David Rosen, PhD, are co-authors of the study.

In 2008 and 2009, the research team tested 22,134 new prison inmates for HIV, using excess blood collected for mandatory syphilis testing. Overall, 1.45 percent (320) of the inmates tested HIV-positive. Merging test results with records from the N.C. Department of Health and Human Services revealed that 93.8 percent of these inmates – all but 20 – had a record of a positive HIV test prior to incarceration.

The relatively low prevalence of undiagnosed HIV among those entering state prison suggests that an emphasis on screening incoming inmates to detect HIV may not be warranted.

“Other at-risk populations with higher levels of undiagnosed HIV infection may constitute a higher priority for screening for HIV than prisoners,” the authors concluded. “Of all new HIV diagnoses in North Carolina in 2008 and 2009, fewer than 2 percent were prison entrants.”

At the time the study was conducted, HIV testing in the North Carolina state prison system was voluntary. In July 2013, the state passed a bill requiring all prisoners to be tested for HIV at entry, every four years during incarceration, and at release.

Study co-authors are Carol Golin, MD, Jeanine May, PhD, and Becky White, MD, of the UNC Sheps Center for Health Services Research, and David Rosen, PhD, of the UNC School of Medicine. Golin also is associate professor of health behavior in the Gillings School of Global Public Health. White and Rosen are Gillings School alumni.

The National Institute of Drug Abuse at the National Institutes of Health funded the research.